1. Team Leaders: Judy Canfield Dr. Laurie Amundsen
SIP 1
Team Leaders:
Judy Canfield
Dr. Laurie Amundsen

2. Charter
Scope: From patient’s decision of having surgery until 00:01 on the day of surgery.
In Scope:
Patient scheduling of surgery; Pre-Anesthesia, Lab – including day of surgery; Discharge Planning; Financial Clearance; patient packet; interface to: Med Consult, Radiology, Pathology, Cardiology, Lab appointments; Scheduling Systems: scheduling coordination with PL’s; Communication of special needs – implants, ICU beds, bariatric equipment, etc.; In-patient preparation
Out of Scope:
Preparing instruments, supplies, and equipments;
Outcome Deliverables
Document current state process(es)
Document best industry practices
Value analysis using LEAN methodology
Identification of optimal patient flow (patient experience)
Identification of optimal information flow
Identification of essential variability
Design future state process(es)
Develop project plan and timeline
Identify short and long term projects
Develop metrics and key indicators
Short and long term project completion
Strategy for ongoing Performance Improvement
Essential Metrics
Patient ready upon arrival
All resources ready upon arrival
Block time utilization
Planned schedule same as actual schedule
Where the team has focused its efforts due to the need for integration of all teams for Patient Preparation and Document Management

3. Condensed Process Map
Core process

4. Key Areas of Improvement
Patient Flow
Scheduling
PAC
Supplies
Equipment
Scheduling Cases
Preparing for Surgical Cases
Accessing Patient Data
RPI Recommendation
Case Cart
Patient Preparation
Document Management

5. Condensed Process Map
Scheduling Cases Map

6. Scheduling Cases Issues
Patient Flow
Scheduling
PAC
Supplies
Equipment
Scheduling Cases Issues
Case selection, via PCC, is by procedure name.
Case selection drives the preference list that is chosen for the case.
SCCA patients decide day ahead for surgery and require intense coordination.
Each team member has different definition for surgery time estimate.
Room scheduling is not standardized- Pavilion and Main OR have different rules.
Cases are moved 24 hours ahead after review by charge Anesthesia/Nurse staff for correct room assignment.

7. Condensed Process Map
Preparing for Surgical Case Map

8. Preparing for Surgical Case Issues
All systems are manual, which is resource- and labor-intensive.
Preference lists/ pick tickets are not frequently reviewed the day ahead, resulting in the wrong case cart.
There is no standard for how information is received, reviewed and actions taken.
PCCs are located in multiple sites.
Getting the patient access to essential services in surgical preparation is difficult.
Anesthesia bypass process of the surgical patient is complicated and inconsistent.

9. Condensed Process Map
Accessing Patient Data

10. Accessing Patient Data Issues
Information received from outside referral does not always make it to the chart.
All document elements for the pre-surgical patient are not accessible to the requisite and appropriate staff.
Yellow packet travels across sites, and is only accessible to the site where it currently resides.
Records are lost causing case delays and errors.
Document completion is not standardized across surgical clinics.

11. RPI – Case Carts

12. Past and Current Activities
Completed PCC ESI training
Reviewed and evaluated best practice scheduling process from other academic medical centers
Reviewed literature
Created website for open and released block time
Established concepts for a best practice scheduling process
Developed Best Practice scheduling process vision (includes inpatient)
Established shared definitions
Developed standard physician worksheet
Created criteria/guidelines for scheduling TBA cases
Flexible scheduling process for cases that need 24 hour turnaround of schedule (i.e., cancer, orthopedic injuries)

13. Best Practice Scheduling Process Recommendation
Process for scheduling is standard for both inpatient and outpatient cases by the PCC
Patient and Physician determination of surgical procedure
Standard Worksheet completed – essential elements
MD determines and is accountable for procedure name, duration and preference list from data sheet with his/her specific cases and PLs
Information is entered into ESI and scheduled by PCC
Cases are scheduled to accommodate patient preferences and special needs
Scheduler acknowledges work submitted
PCC places case in block time
If no block is open
48 hours before day of surgery – charge personnel checks surgery schedule for fit, moves TBA cases into open block and communicates these to services
PCC reviews web site for released time
If no released time available
PCC places case in TBA schedule

14. Next Steps Key Reality Checks Develop future metrics
Develop implementation plan for new scheduling process
Develop plan for elements not discussed (due to time constraints) but of importance
Key Reality Checks
Will this make our scheduling process easier? 
Will it flow better and have more accuracy? 
Does our process give feedback to those using it?

15. SIP1 Team

16. Appendix

17. Comments/Questions from OR staff and department road shows
Patients have lots of history but we cannot get/retrieve the record.
PCCs have a lack of training in choosing the right PLs. Do we as the OR need to embrace training and collaborate with the PCCs?
Because of the acuity of our patients, the day before the appointment in the Pre-Anesthesia Clinic is not enough lead time to prepare for the patient.
Inpatients should be seen by the Pre-Anesthesia Clinic also.
We are still getting incomplete instrument sets and wrong items in the case carts.
Continuity of preop evaluation and on-site anesthesia management.
Crisp definitions of time that make sense to the surgeons.

18. Review and Evaluation of Other Scheduling Practices
*Please note that this is only a small portion of the informal survey

19. Literature Review Sample
Schedule the Short Procedure First to Improve OR Efficiency – Lebowitz, Phillip, MD, Oct 2003
What makes a well-oiled scheduling system? – OR Manager
Determining Optimum Operating Room Utilization – Tyler, D et al., 2003
How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time –Dexter and Traub, 2002
Optimal Sequencing of Urgent Surgical Cases, Dexter et al., May 1999
Creating an Optimal Operating Room Schedule, Calichman, Murray, May 2005
Applications of Queuing Theory, Vanaswala and Desser, Feb 2005
Improving Operating Room Coordination, Moss and Xiao, 2004